Jumat, 15 Juli 2011

Institutions

Institutions
 When the General Agreement on Tariffs and Trade (GATT) was signed by over 100 countries in 1994, it was to have profound direct and indirect implications for public health in
Health
Sciences
                                                                           Culture
                                                                                                        Urban life Plants
                        Rural life
Climate
                                                                                                        Light
Earth Ecology Animals Biodiversity
                                                                           Water
Figure 4.4
Food’s impact on health: the complex model (from Waltner-Troews and Lang, 2000) with permission.

general, and for food and agriculture in particular. It created the immensely powerful World Trade Organization (WTO) which not only monitors trade rules but runs a system of arbitration which is de facto a new jurisprudence. This mattered for public health for a number of reasons.
The institutions through which public health has expressed its views in the post-war period have been quietly marginalized (Labonte, 1998). A new system of world governance, much commented on by its non-governmental organization (NGO) critics, is emerging in parallel to, and more powerful than, the formerly more democratic institutions of the United Nations (Navarro, 1999). The WTO (or the World Bank) is more significant in framing the conditions for public health than the WHO (Banerji, 1999). The WHO is informed by a World Health Assembly, yet there is no parallel citizen’s voice for the WTO. Economically, there is no contest as to which is more significant, the UN system or the new trade system.
The GATT is a key, if not the key, structure in the architecture of the new era of globalization. Within the many hundreds of pages of the full GATT agreement, public health barely registers, except when implied as a threat to free trade. A fear that health is a fig-leaf for protectionism stalks the neoliberal halls, whereas to proponents of public health, the notion of “protection”, like prevention, carries positive rather than negative connotations. In the GATT’s Agreement on Agriculture much effort was put into ensuring that national governments cannot set food standards or restrict entry of foods unless they have “sound scientific” justification. This seems reasonable, although in practice subject to subjective interpretation and commercial pressures.
Research conducted in 1991–93, before the 1994 GATT was signed, suggested that Codex was not in a fit democratic state to carry public confidence about its processes (Avery et al ., 1993). Codex is a large system of around 20 committees, which has many participants at meetings around the world. These working parties are usually hosted by rich countries and meet over two years and make recommendations to the bi-annual full meeting of the Codex Commission. Over the full 1991–93 cycle of meetings there were a total of 2758 participants. Codex is theoretically a meeting of governments but the study found that nearly a quarter of participants were from large international companies – the same for whose products were being set standards. Reviewing a full two-year cycle of Codex meetings, the
Cracking the Codex study found that:
• 104 countries participated, as did over 100 of the largest multinational food and agrochemical companies;
•The vast majority (96%) of nongovernmental participants represented industry;
• There were 26 representatives from public interest groups compared to 662 industry representatives;
• Nestl√©, the largest food company in the world, sent over 30 representatives to all Codex committee meetings combined, more than most countries;
• Most representation came from rich, Northern countries: over 60% came from Europe and North America with the poor countries of the South dramatically under represented – only 7% from Africa and 10% from Latin America;
• Of the participants on the working group on standards for food additives and contaminants, 39% represented Transnational Corporations (TNCs) or industry federations, including 61 representatives from the largest food and agrochemical companies in the world;
• Of the 374 participants on the committee on pesticide residue levels, 75 repre- sented multinational agrochemical and food corporations, 34 from the world’s top 20 agrochemical companies; only 80 participants represented the interests of developing countries;
• The USA sent more representatives to Codex than any other country (50% of them representing industry) and almost twice as many as the entire continent of Africa.
Following the publication of this report and despite requests to “clean up” this inadequacy, the GATT secretariat declined to act. In subsequent years, officials and companies became sensitive to these criticisms, which have been pursued by the consumers’ movement. Some countries now hold tripartite national premeetings with industry, consumers, and government officials before going to Codex meetings. However, this left practice at the Codex meetings themselves unchanged. One review in 1997 concluded that little has changed (McCrea, 1997). At the 1997 Codex food labeling committee, for instance, the US delegation comprised eight government officials, three from NGOs and ten from industry. Reform is now, happily, beginning, but why so late?
Particularly sensitive is the issue of scientific judgment. The GATT stipulated that disputes would be arbitrated on grounds of “sound science”, yet consumer groups argue that science is not the only salient feature, nor indeed is science quite the straightforward arbiter it is assumed to be. Whose is the research? Who funded it? Is it publicly available? What questions framed the analysis? The argument between the USA and the EU over hormone use in meat fattening illustrates the sensitivity of the issue. Since the early 1980s, the EU has implemented a ban on the use of hormones. This was con-tested by the US, keen to sell its beef in Europe’s rich markets. The dispute was referred to Codex and the long-awaited WTO decision was announced in early 1998. Both the US and EU claimed vindication of their positions (EC, 1998; USTR, 1998). The EU’s Scientific Committee on Veterinary Measures then argued that further studies suggested scientific evidence warranting a continued ban (European Commission, 1999).
 The food trade issue is now particularly sensitive. For the last few years there has been a steady stream of high profile cases where food-exporting nations fight over the right to export surpluses to each other and to markets they deem their own. There have been wars over lamb between Australia and New Zealand and the USA (International Centre for Trade and Sustainable Development, 1999); over beef hormones between the EU and USA; over genetically modified foods between the USA and many countries but especially the EU. The notion that food security stems from growing most of one’s food within one’s country (what used to be called self-reliance) is being eroded by the notion that security stems from being able to purchase food on the open world markets (WHO-Europe, 1995).
Food security is a concern for most developing country governments whereas rich countries are more troubled by consumer-driven food safety issues. As the WHO Regional Office for Europe’s (1999) Food and Nutrition Plan recognizes, from a public health perspective, both are important and both re ect changes in methods of production and distribution and in the food system (Tansey and Worsley, 1995; Lang, 1997). The Norwegian Government was rare among rich nations in openly criticizing the drift of the new GATT talks. It should know. Its citizens voted in the early 1990s against joining the EU, in part from hostility to the Common Agricultural Policy undermining the national nutrition and food policy in place since 1976 (Royal Norwegian Ministry of Agriculture, 1976). Yet Norway by signing onto the 1994 GATT began to erode exactly the very same national policy.
In a paper prepared in June 1999, Norway laid down a clear policy challenge: food security is too important to be left to the vagaries of trade (Royal Ministry of Agriculture, 1999). Under the Plan of Action agreed at the 1996 World Food Summit, as at the earlier 1992 International Conference on Nutrition, Governments agreed they have a moral responsibility to ensure their citizens have adequate food, are free from hunger and achieve food security (World Food Summit, 1996). The GATT perspective favors the market approach to food security. Tacitly, it argues that the cheapest food is best. The new public health perspective suggests that the West’s food revolution has intensified food production such that when food is cheap, other costs are being externalized onto the environment (Lang, 1999b). In this intellectual context, Norway’s position was pioneering. It argued that the new Round should agree on rules to safeguard national food security. When wheat or maize prices can rise by 50% in just two years, as happened in 1993–95, reliance on being able to buy one’s food in the world marketplace is a form of security only open to the af uent. (Norway, as a small population with immense oil wealth is ironically one such country.) What are the poor to do in such circumstances: tighten their belts? As Sen (1981b, 1997) and others have shown, hunger follows poor purchasing power and is not necessarily a function of food availability.
The new WTO structures are designed to facilitate cross-border economic activity and to reduce national control over capital  ows, competition and even cultural control. In the age of the internet, information knows few boundaries yet vast new corporations are emerging which dominate almost everything humans do or consume. The irony about the new GATT is that it is based upon the free trade model of globalization just when evidence about its negative effects is mounting up. According to the tenth annual UN Human Development Report, the richest 20% of the world now account for 86% of world GDP, while the poorest 20% have just 1% (UNDP, 1999); 200 of the world’s richest people have doubled their net worth in the last four years. The richest three people in the world have assets greater than the combined Gross National Product of all the least developed countries in the world, 600 million people. There is little chance of health for all in such a socially divided world.
Another reason for public health involvement in trade talks and debate concerns the work of public health monitoring itself. Public health action has to be based on a good understanding of the real world. Perspective is in order. Postwar development has brought astonishing gains for billions of people, but equally, as the Human Development Report documents, the scale of contemporary inequality and poor healthcare defies sanity. The Human Development Report itself came into existence because a decade ago, UN administrators, social scientists, and politicians were critical of the convention of measuring development through indicators such as Gross Domestic or National Product. They disguise intranational inequalities and fail to convey the quality of life issues. The Human Development Index was created to fill this gap. The Human Development Report shows that 80 countries have incomes lower today than a decade ago; 1.3 billion people, over a fifth of humanity, exist on less than US$1 per day. However it is measured, the gap between the richest and poorest is widening. In 1960, the gap between the richest fifth and the poorest fifth was 30:1. In 1990 it was 60:1. In 1997 it was 74:1 (UNDP, 1999). In this context, it is clear that epidemiologists as much as physicians and health activists have to ask themselves how their work does or does not confront this obscene accrual of wealth and power. And does the nutrition transition call for new health indicators? Almost certainly, yes!
The Human Development Report , however, argued that globalization is unstoppable and that all good people can do is try to give it “development with a human face”. It is true that proponents of unfettered free trade are more defensive than in 1987–94. Faced by growing opposition and the sheer weight of evidence of harm, the architects of inequalities in health now plead that we should still trust them and that (their version of) growth must continue by a different path (Wolf, 1999). Inequalities may be bad, they admit, but now is the time to target resources on the poor. We should ignore, they imply, the accrual of power by the rich as they are the motor force of the new global economy.

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